An international study of patient compliance with hemodialysis

Context International differences in compliance of patients undergoing hemo dialysis are poorly characterized and could contribute to international sur vival differences. Objective To compare international differences in patient compliance with h emodialysis treatments. Design A prospective observational study of patients undergoing hemodialysi s in 1995 and a cross-sectional survey of health care professionals caring for hemodialyzed patients in 1996. Setting and Patients Four dialysis centers in the southeastern United State s with 415 patients undergoing hemodialysis, 1 center in Sweden with 84 pat ients, and 4 centers in Japan with 194 patients participated in the prospec tive observational study. In the cross-sectional survey, nurses and nephrol ogists from the United States (n = 49), Japan (n = 21), and Sweden (n = 16) responded to questions regarding the compliance of their patients undergoi ng hemodialysis. Main Outcome Measures Percentage of patients who miss a dialysis treatment and number of missed dialysis treatments. Results Of 415 US patients, 147 missed 699 treatments over a 6-month period (28.1 missed treatments per 100 patient-months or 2.3% of all prescribed t reatments). During a 3-month period, there were 0 missed treatments per 100 patient-months for patients from Japan and 0 missed treatments per 100 pat ient-months for patients from Sweden (P<.001). In the cross-sectional surve y, the mean (SD) estimated percentage of patients missing a treatment per m onth was 4% (3%) for the United States, 0% for Japan, and 0.1% (3%) for Swe den (P<.001). Conclusions Noncompliance is much more common in US patients undergoing hem odialysis than Swedish and Japanese patients. The implications of these res ults for international differences in survival deserve further study.